|
HC PREGNANCY TEST URINE
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
910400131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.16
|
| Rate for Payer: Heritage Provider Network Senior |
$163.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.25
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
IP
|
$3,766.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$681.65 |
| Max. Negotiated Rate |
$2,824.50 |
| Rate for Payer: Adventist Health Commercial |
$753.20
|
| Rate for Payer: Cash Price |
$2,071.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,549.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,549.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$681.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.50
|
| Rate for Payer: Multiplan Commercial |
$2,824.50
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
OP
|
$3,766.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$753.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,012.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,587.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,071.30
|
| Rate for Payer: Cash Price |
$2,071.30
|
| Rate for Payer: Cash Price |
$2,071.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,447.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Senior |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$295.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,549.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,549.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,796.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$681.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.78
|
| Rate for Payer: Multiplan Commercial |
$2,824.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,355.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,246.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC PREPARE OF FECAL MICROBIOTA
|
Facility
|
IP
|
$1,595.00
|
|
|
Service Code
|
CPT 44705
|
| Hospital Charge Code |
906700705
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$288.69 |
| Max. Negotiated Rate |
$1,196.25 |
| Rate for Payer: Adventist Health Commercial |
$319.00
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,079.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,079.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.75
|
| Rate for Payer: Multiplan Commercial |
$1,196.25
|
|
|
HC PREPARE OF FECAL MICROBIOTA
|
Facility
|
OP
|
$1,595.00
|
|
|
Service Code
|
CPT 44705
|
| Hospital Charge Code |
906700705
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$319.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,095.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,355.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$877.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,036.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,355.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,355.75
|
| Rate for Payer: Dignity Health Senior |
$1,355.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$987.30
|
| Rate for Payer: Heritage Provider Network Senior |
$987.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$760.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,116.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,116.50
|
| Rate for Payer: Multiplan Commercial |
$1,196.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$797.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$797.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,355.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,355.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,355.75
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$172.49 |
| Max. Negotiated Rate |
$714.75 |
| Rate for Payer: Adventist Health Commercial |
$190.60
|
| Rate for Payer: Cash Price |
$524.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$645.18
|
| Rate for Payer: Heritage Provider Network Senior |
$645.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.25
|
| Rate for Payer: Multiplan Commercial |
$714.75
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$72.95 |
| Max. Negotiated Rate |
$714.75 |
| Rate for Payer: Adventist Health Commercial |
$190.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$509.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$654.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Blue Shield of California Commercial |
$214.70
|
| Rate for Payer: Blue Shield of California EPN |
$172.66
|
| Rate for Payer: Cash Price |
$524.15
|
| Rate for Payer: Cash Price |
$524.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$619.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Senior |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$619.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$395.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$589.91
|
| Rate for Payer: Heritage Provider Network Senior |
$589.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$454.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.53
|
| Rate for Payer: Multiplan Commercial |
$714.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$435.23
|
| Rate for Payer: TriValley Medical Group Senior |
$395.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$476.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$476.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC PREP SPLIT UNIT
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
900904439
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$202.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$260.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.04
|
| Rate for Payer: Blue Shield of California Commercial |
$231.19
|
| Rate for Payer: Blue Shield of California EPN |
$184.95
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$246.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$234.60
|
| Rate for Payer: Heritage Provider Network Senior |
$234.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$239.50
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC PREP SPLIT UNIT
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
900904439
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$284.25 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$256.58
|
| Rate for Payer: Heritage Provider Network Senior |
$256.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.75
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$421.09
|
| Rate for Payer: Heritage Provider Network Senior |
$421.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.50
|
| Rate for Payer: Multiplan Commercial |
$466.50
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$427.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.50
|
| Rate for Payer: Blue Shield of California Commercial |
$737.66
|
| Rate for Payer: Blue Shield of California EPN |
$593.20
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.70
|
| Rate for Payer: Dignity Health Senior |
$528.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$296.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.40
|
| Rate for Payer: Multiplan Commercial |
$466.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$311.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$311.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.70
|
| Rate for Payer: Vantage Medical Group Senior |
$528.70
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Blue Shield of California Commercial |
$56.73
|
| Rate for Payer: Blue Shield of California EPN |
$45.38
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Senior |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.57
|
| Rate for Payer: Heritage Provider Network Senior |
$57.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.70
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.12
|
| Rate for Payer: TriValley Medical Group Senior |
$47.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.96
|
| Rate for Payer: Heritage Provider Network Senior |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR DC
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 0804T
|
| Hospital Charge Code |
906819787
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR DC
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 0804T
|
| Hospital Charge Code |
906819787
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Senior |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$58.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$90.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.70
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.12
|
| Rate for Payer: TriValley Medical Group Senior |
$47.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Cash Price |
$56.65
|
| Rate for Payer: Cash Price |
$56.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$56.65
|
| Rate for Payer: Cash Price |
$56.65
|
| Rate for Payer: Cash Price |
$56.65
|
| Rate for Payer: Cash Price |
$56.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Senior |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$58.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$90.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.70
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.12
|
| Rate for Payer: TriValley Medical Group Senior |
$47.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$19,611.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,549.59 |
| Max. Negotiated Rate |
$14,708.25 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,549.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,902.75
|
| Rate for Payer: Multiplan Commercial |
$14,708.25
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$19,611.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,549.59 |
| Max. Negotiated Rate |
$14,708.25 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,276.65
|
| Rate for Payer: Heritage Provider Network Senior |
$13,276.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,549.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,902.75
|
| Rate for Payer: Multiplan Commercial |
$14,708.25
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$19,611.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,472.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,139.21
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$656.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,549.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,902.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$14,708.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$17,053.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906820231
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,086.59 |
| Max. Negotiated Rate |
$12,789.75 |
| Rate for Payer: Adventist Health Commercial |
$3,410.60
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,086.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,263.25
|
| Rate for Payer: Multiplan Commercial |
$12,789.75
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$19,611.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,472.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,747.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,139.21
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$656.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,549.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,902.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$14,708.25
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$25,097.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$17,053.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906820231
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$3,410.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,715.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,555.81
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$656.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,086.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,263.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$12,789.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
IP
|
$14,320.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
906820198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,591.92 |
| Max. Negotiated Rate |
$10,740.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,694.64
|
| Rate for Payer: Heritage Provider Network Senior |
$9,694.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,591.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,580.00
|
| Rate for Payer: Multiplan Commercial |
$10,740.00
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
OP
|
$14,320.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
906820198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,172.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,837.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,876.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,740.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,308.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,172.00
|
| Rate for Payer: Dignity Health Senior |
$12,172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,864.08
|
| Rate for Payer: Heritage Provider Network Senior |
$8,864.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,389.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,830.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,591.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,580.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,024.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,024.00
|
| Rate for Payer: Multiplan Commercial |
$10,740.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,172.00
|
|
